Why Self-Care Pain Medicine?
April 15, 2014
Chronic pain is a major problem and takes a terrible toll not only on individuals suffering from chronic pain but also on our health care system at large. Addressing it is the responsibility of us all, but we have fallen into a trap.
The massive amount of money invested in research, advertising, and delivery of drugs (nearly $30 billion a year in each activity), especially opioid medications, and other expensive, practitioner-dependent interventions for the treatment of pain has overwhelmed our approach to this condition and obscured other less expensive and more sustainable treatments, particularly those that patients can do themselves.
As stated by COL Chester Buckenmeier III and LTG (RET) Eric Schoomaker in the preface article of a new report published by Samueli Institute as a supplement to Pain Medicine this month:
“At its most basic, pain has been seen historically as a symptom of some other disease or trauma, rather than a disease process of the central and peripheral nervous system that medicine now understands chronic pain embodies. Both the Institute of Medicine and Pain Management Task Force reports charged the medical community to acknowledge that effective pain management requires therapies that treat the whole patient, both physically and through a holistic biopsychosocial model, while also educating the country that chronic pain is a national health problem.”
More holistic, active, self-care, complementary, and integrative medicine (ACT-CIM) therapies, if effective, should be more sustainable and cost-effective than drug and practitioner dependent treatments. In addition, they are likely to provide additional benefits such as the enhancement of self-efficacy, lower cost, and be self-directed.
But are they effective and, if so, which ones and at what intensity and duration?
It is the purpose of this systematic review to determine which ACT-CIM therapies are effective in pain management.
The systematic review process, known as the Rapid Evidence Assessment of the Literature (REAL©), used for reviewing this information has been developed by Samueli Institute over a number of years. It includes a combination of current state of the art systematic review methodologies and a balanced expert panel process to make evidence-based recommendations for research, practice, and policy.
The authors discuss the review’s methodology and results throughout the supplement. ACT-CIM modalities included in this review were categorized into the following groups and assessed for efficacy: mind–body therapies, movement therapies, physically-oriented therapies, and sensory art therapies.
Multi-modal integrative approaches and ACT-CIM approaches, when directly compared with each other, were also assessed for effectiveness. Each of the Pain Medicine articles describes the review’s results for each category, detailing the quality of individual studies as well as subject matter expert recommendations based on analyses of the overall literature pool. Additionally, the authors also describe which ACT-CIM modalities may be most effective for different types of chronic pain conditions and provide suggestions for next steps for moving this field of research forward.
Based on the results of this extensive review, weak recommendations were given in favor of using yoga, tai chi, and music for the self-management of chronic pain symptoms. No recommendations, moreover, could be given for mindfulness/meditation, relaxation, self-correcting exercises, biofeedback, acupressure, transcutaneous electrical nerve stimulation, Qi Gong, autogenic training, guided imagery/self-hypnosis, journaling, and storytelling. Many of these modalities are already in fairly extensive use in medicine. However, given the poor state of the research, it is likely that they are not being used most effectively or efficiently.
It is clear that a substantially greater investment in researching ACT-CIM areas is urgently needed. In addition, significant improvements are needed in quality research if gains are to be made in these types of approaches. Currently, there are few economic drivers to do research on or use many of these modalities and so we end up not knowing enough about their safety and efficacy to recommend them. Without such an investment or policies that create such drivers, ACT-CIM therapies for pain will likely only slowly gain acceptance and use.
We hope that this supplement issue on the state of the science for these approaches can catalyze further investment in research and adoption of these most important approaches. Those with chronic pain cannot afford to wait.
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Wayne B. Jonas, MD
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